School-aged children with spina bifida meningomyelocele and hydrocephalus (SBH) have characteristic cognitive and academic impairments in several domains that constrain school success and limit employment opportunities. There is agreement that they exhibit; tangential, verbose and stereotypical speech; non-inferential understanding of what they see and hear; deficit reading comprehension; and poor mathematics skills. Yet, there is little hypothesis-driven research that analyzes how impairment in these domains is related to core cognitive deficits and that analyzes how impairment in these domains is related to the type and extent of brain dysmorphology within the SBH condition. In Project 5, 335 children with SBH between the ages of 8 and 15 years will be tested, along with 96 controls. The Project has two aims: 1. To determine whether a limited number of core deficits can explain cognitive outcomes in school-aged children with SBH. This is accomplished by hypothesis-driven testing of core cognitive processes known to contribute to functioning in the domains of impairment that characterize children with SBH; 2. To test hypotheses about the relation between core deficits and the specific brain dysmorphologies and medical characteristics of SBH, thus linking this project to Projects 3,4 and Core B in which the cerebellum, corpus callosum and other brain regions of interest and medical variables are studied in some detail. This project will provide unique information about the cognitive and biological sources of variability in discourse and academic skills in children with SBH, with important implications for school functioning and vocational adjustment.